Active NPI
Barbara Kellogg Gannon, PSY.D.
- Clinical Psychologist
- Gloucester, MA
National Provider Identifier
1801406103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7950-PY-PR
- Practice address
- 30 Western Ave Ste 209
Gloucester, MA 01930-3664 - Phone
- (978) 290-2539
- NPI assigned
- Aug 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7950-PY-PR | MA | Primary |
Addresses
Primary practice location
30 Western Ave Ste 209
Gloucester, MA 01930-3664
Mailing address
30 Western Ave Ste 209
Gloucester, MA 01930-3664
Phone (978) 290-2539
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7950-PY-PR | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596412800000",
"number": "1801406103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 WESTERN AVE STE 209",
"city": "GLOUCESTER",
"state": "MA",
"postal_code": "019303664",
"telephone_number": "978-290-2539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 WESTERN AVE STE 209",
"city": "GLOUCESTER",
"state": "MA",
"postal_code": "019303664",
"telephone_number": "978-290-2539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "BARBARA",
"middle_name": "KELLOGG",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-03",
"last_updated": "2020-08-03",
"certification_date": "2020-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7950-PY-PR",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gloucester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.